BariatricTV ForumGeneral WLS InformationDSWhy is the DS not very common?
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mandi
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« on: February 15, 2010, 06:11:52 PM »

So I've been researching everything I can about WLS and I really like the DS so far. It seems like it is ideal for my situation, and I really like the fact that it keeps the stomach more or less intact (vs RNY that bypasses the pylorus entirely and leaves a blind stomach which worries me, tbh.) The DS has some awesome results, especially long-term for folks like me with a bmi of over 50. (I know RNY has great results too, but I keep going back to the previous concerns about that..)

Now the problem I'm seeing with the DS is that it's not very commonly performed. My local hospital does lapband and RNY and that's it. I've been looking for surgeons that do the DS but they seem somewhat few and far between. It makes me wonder.... Why is the DS not common if it has such great results? Is it considered experimental still? Is it the higher mortality rate (due to pancreatic problems during surgery, probably)?
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« Reply #1 on: February 15, 2010, 09:06:35 PM »

Wow...interesting question.

I'll have to research it a little.  I know if you go to OH board, there are a lot of people very passionate about their DS.


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mandi
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« Reply #2 on: February 15, 2010, 09:12:05 PM »

Definitely - just checked out the OH board recently and got some good info. Really helped me come closer toward a decision about it too. But it's just upsetting since my insurance definitely covers RNY but probably(?) doesn't cover DS unless a doctor recommends it... but at my hospital they only do RNY so they probably won't recommend something they aren't very familiar with (or don't perform themselves). It's pretty discouraging.
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shepkatt
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« Reply #3 on: February 16, 2010, 06:48:05 AM »

OH has a fantastic DS board with lots of good info!  There is a lady on that board, Diana Cox, that has really good info about the legal ins and outs of getting a DS.. Do a search for her posts, or find one of her posts.. I think she has links in her signature to lots of good info.
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T2Nashville
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« Reply #4 on: February 16, 2010, 06:50:44 AM »

Yes, keep researching, Mandi. I have good friends on the Tennessee OH board who are passionate about their DS as well. We have several docs here in Nashville who are doing it with great results. I decided on my sleeve for several reasons, but one of them was that if I need revision in the future, the sleeve is just the first part of a DS, so I can go further if I need to. I hope I don't, but at least I have the option. Most of my DS friends here also had a BMI over 50, and they are doing great!
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mandi
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« Reply #5 on: February 16, 2010, 08:42:23 PM »

Thanks guys! I have been researching my eyes out, and I'm pretty much sold on the DS. I've contacted a few surgeons to get more info about their experience with the DS, and I'm hopefully going to start the scary insurance stuff in early March. I'm really hoping to get surgery over the summer since I'm a grad student and want to be back in by fall... That's my goal anyway!

I posted the same question over at OH and they pretty much concluded that it comes down to insurance companies not wanting to spend more for the surgery that has comparable results to the RNY. It always comes down to money, doesn't it?  Roll Eyes
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« Reply #6 on: February 17, 2010, 07:08:48 AM »

Yep it does.  I wanted the DS but insurance said no.  Dr Houston at Centiennal in Nashville, TN did my RNY and is having good results with the DS.  He has done the RNY for years, but had only been doing the DS for a little over a year.
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Paula
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« Reply #7 on: April 06, 2010, 06:26:49 AM »

I just saw my surgeon on Thursday and here is what I was told about the DS.  In his opinion, DS people do well initailly, but then end up with MAJOR malabsorption problems several years down the road, many of which can't be overcome and end in sever health issuses, even death.  It's the nature of the beast for people to slide in no taking their vitamens, which can be fatal in DS.  Also, a RNY or a VSG has about a 1 in 500 fatality rate in the first month, from surgery to 30 days post surgery, but DS had a 2 in 100 chance of fatality.  That is the reasons alot of surgeons don't do it, and why insurance won't often pay for it.  Just what I was told.
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MacMadame
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« Reply #8 on: April 06, 2010, 09:15:52 AM »

Let me guess... your surgeon doesn't perform the DS.  Tongue

My surgeon does all 4 surgeries and what he says is that your risk of malnutrition is higher with the DS, but that he recommends it for patients with a lot of weight to lose as then the benefits (better weight loss) outweigh the risks (greater risk of complications).

The reason why a lot of surgeons don't perform it is that it's a complicated operation that takes a long time and therefore is expensive (for self-pays and insurance) and less profitable (for the surgeon). So it's a combination of being skilled enough and willing to go through a long learning curve for an operation that doesn't have a high profit margin and was once quite dangerous (when they did it differently). Lots of surgeons decided that it just wasn't worth it to learn to do it given all that. Of course, it's much safer these days, but part of that is that it can be done laparoscopically and that raises the skill level needed to perform it.

Btw, the chances of dying from VSG or RnY are not 1 in 500. Those are very old statistics and not reflective of modern procedures. (And it's not 1 in 100 for DS either.) Bariatric surgery today is no more risky than any routine laparoscopic surgery such as having your gallbladder out. The "dead in 30 days" stat is more like 1 in 2000 these days.
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Jazzbabe
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« Reply #9 on: January 26, 2011, 07:19:18 AM »

Mandi-

Many DSer's have traveled to other cities...and even other countries...to have this surgery. 

A couple of reasons it's not more common is that it is a more complex procedure than the RNY, and according to much of the literature, roughly 50 surgeons perform the surgery worldwide.  I think there may be more US surgeons performing the procedure now than there were when most of the literature was written.

I can tell you from my own experience, and seeing first hand from my support group what happens to RNY's further out (almost total regain, some get back more than they lost), I am SO glad that I have the DS, whichh is a lifetime tool.  I am at 93% EWL (excess weight lost), and am now looking into reconstructive surgery. 

Look through the Obesity Help DS board, www.dsfacts.com and www.duodenalswitch.com  for more information on this weight loss surgery that changes lives FOREVER!

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shepkatt
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« Reply #10 on: January 26, 2011, 08:02:32 AM »

I agree that DS has a fabulous success rate.. 

From my personal history I have only known a few RNYrs who gained back all their weight.  The key, I think, in any surgery is staying connected.  If you lose all your weight and get cocky and lose your connection with the community of people who are just like you - those are the people who I see coming back months/years after they have reached goal and are now looking for support to help them get back on track..  Stay connected..  Once you have the surgery (any weight loss surgery) you are a Surgically Altered Freak and you need to keep in contact with your own kind.. :-)

So yeah.. regain happens to some.. but not all.   Everyone needs to make the decision on the type of surgery that will work best for them and their lifestyle after doing their due diligence..

I am so happy we finally have some DS representation on this forum.. 
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Maria C
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« Reply #11 on: February 05, 2011, 07:39:09 PM »

From my research I have noticed that Surgeons who do not perform the Duodenal Switch like to trash talk it. I believe that the best thing someone can do for themselves is becoming informed on all the procedures. If that involves seeing multiple surgeons then so be it. The way i look at it is like buying a car or a house. We will shop around for the best deal and the most information when buy these things then why should be just sit there and believe what one surgeon tells us??.. Just because they have a medical degree doesn't mean they are always right. The Duodenal Switch is a lot more complicated than the RNY, VSG, and of course the band, which is one of the major reasons why not many surgeons perform it.

I saw someone mentioned that DS patients have initial success then suffer from malabsoprtion problems that lead to health issues and even death. I will agree that this CAN be true, because well lets face it, it is true with ALL surgeries. Death is always one of the risks right?... However the surgery is more developed now and a lot of these "rumors" that are spread around are from the old Biliopancreatic diversion (BPD) procedure that was done many years ago. Yes the DS has a malabsorptive component, but it is one of the main reasons that it is so successful. Anyone that decides to have the DS needs to be aware of all the responsibilities involved after surgery in order to stay healthy and nourished. DS patients need to make many more supplements and vitamins than other WLS patients, sometimes up to 44 pills per day. Need to have lab works done regularly and a bone density test every two years to  make sure that your normal calcium levels are because you are getting calcium from supplementation and not from your bones. And you must ingest at least 100g of protein daily.

Some surgeons, including mine, are a little more conservative about the length of the common channel. They will make the CC longer and make the Sleeve smaller to make up for the extra absorption. This helps have less, more regular bowl movements and less malabsorption problems. You can discuss this with your surgeon of course if it is an option you would prefer.

Of course if by reading any of this you say, HELL NO, that is way too  much up keep then you know DS is not for you. Smiley ... I only encourage everyone out there to make an informed decision. You are going in to make a huge decision, make sure you know everything about every surgery. The good , the bad, and the ugly ... not every surgery is right for everyone. However, at the end of the day you want to make sure that when you look back, you feel you  made the right choice and not wish that you had looked at all your available options.

P.S. I am still pre op, please take all my advice with a grain of salt. All my information is from vigorous research. Smiley

<3 Maria
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« Reply #12 on: February 05, 2011, 07:45:54 PM »

Bravo Maria!

Couldn't have said it better myself Smiley

Ian
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« Reply #13 on: February 06, 2011, 01:03:54 PM »

Quote
not every surgery is right for everyone

I think as much of the negative attitude about DS comes from the over-zealous folks that feel that not only is DS the "best" surgery available for weight loss, but tend to look down on those that chose another surgery.

As highlighted in the latest BTV episode, this is a journey... not a race, not a competition. And it's a very personal one at that.

Welcome to BTV, I look forward to hearing more from you and more about your own journey!
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Maria C
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« Reply #14 on: February 06, 2011, 01:44:34 PM »

Quote
not every surgery is right for everyone

I think as much of the negative attitude about DS comes from the over-zealous folks that feel that not only is DS the "best" surgery available for weight loss, but tend to look down on those that chose another surgery.

As highlighted in the latest BTV episode, this is a journey... not a race, not a competition. And it's a very personal one at that.

Welcome to BTV, I look forward to hearing more from you and more about your own journey!



From my small amount of experience I have seen that it is actually the other way around, individuals with other surgeries put down DS because they do not like how "over-zealous" DSers are. However, i also believe that the reason DSers are so pro active about spreading the word about DS is because there isn't enough information out there. Even events like the OH ones are inclined towards the RNY and BAND. If it wasn't for those "over Zealous" DSers that spread the word, i would have never known about the surgery because the original surgeon i went to didn't even mention it to me. I thank them for opening my eyes to all my possibilities.

There are always bad apples in everything, whether it be ethnicity, skin color, social clicks, or WLS. There are individuals in every surgery group that say their surgery is better than the others and trash talk. However only YOU as an individual can decide which surgery is best! ... Smiley ... I personally love the idea of the DS and I do not like the idea of dumping and having a pouch with out my pyloric valve. So for me the best surgery is the DS, that doesn't mean that it is the best surgery for you, or the next person.

<3 Maria
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baka
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« Reply #15 on: February 06, 2011, 02:18:15 PM »

Even events like the OH ones are inclined towards the RNY and BAND.

Actually I was at the OH Conference in Costa Mesa and listened to Dr. Ara Keshishian, who talked about DS & Revision Surgery. I found it really very informative.

This is my opinion with regards the over zealous types (either surgeries not just DS) ...... It's in their DNA/Make-up they are the personalty type who always have to one-up you.... You know the type of people I'm talking about:

1. They listen to your story and then chime in with a bigger better version
2. You talk about your new car...... They have a bigger faster version... blah blah
3. You talk about your party exploits and they drank more and had more sex... etc, etc

I'm betting while in school they got their ass kicked pretty much every day Wink

Ian
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Maria C
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« Reply #16 on: February 06, 2011, 03:36:40 PM »

Even events like the OH ones are inclined towards the RNY and BAND.

Actually I was at the OH Conference in Costa Mesa and listened to Dr. Ara Keshishian, who talked about DS & Revision Surgery. I found it really very informative.

This is my opinion with regards the over zealous types (either surgeries not just DS) ...... It's in their DNA/Make-up they are the personalty type who always have to one-up you.... You know the type of people I'm talking about:

1. They listen to your story and then chime in with a bigger better version
2. You talk about your new car...... They have a bigger faster version... blah blah
3. You talk about your party exploits and they drank more and had more sex... etc, etc

I'm betting while in school the got their ass kicked pretty much every day Wink

Ian



*looking for the "like" button* lol Smiley
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girlygirl1313
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« Reply #17 on: February 07, 2011, 05:48:26 AM »

Quote
not every surgery is right for everyone

I think as much of the negative attitude about DS comes from the overzealous folks that feel that not only is DS the "best" surgery available for weight loss, but tend to look down on those that chose another surgery.

As highlighted in the latest BTV episode, this is a journey... not a race, not a competition. And it's a very personal one at that.

Welcome to BTV, I look forward to hearing more from you and more about your own journey!


Wow, I don't think anyone is dumb enough to choose one surgery over another because one didn't like a certain person's attitude.  That's a ridiculous thought, allowing someone you don't care for to dictate the rest of your life.

  But I must admit that I have been overwhelmed by DSer's positive testimonies for the past two years, the facts they present, the links to stats and studies.  I have been gobsmacked by the PMs and emails I've received answering the toughest of questions and backing them all up with facts and not hearsay.  One even gave me pointers for how to write the most effect appeal letter. 

These 'overzealous' folks you speak of have been there to help me with every step of my journey.  They pay it forward everyday. 
I think the reason some are outspoken is because there is soooo much misinformation being spread about the DS.  And RNY/BAND doctors are the #1 disseminators of false information.  Why is RNY the gold standard? maybe it's because RNY surgeon's pockets are lined with it.

The DS surgery takes a level of skill that most surgeons simply do not possess.  For the time DS takes and it's complexity most surgeons find this to be inhibitive to their profit making potential because the DS doesn't really 'pay out' any more than the RNY.  Multiple RNYs can be performed in one day and the actual skill level needed to perform the RNY is fairly low.  That's why those Docs are peddling on almost every street corner.

As the DS becomes more widely known, more and more insurance companies no longer view it as experimental.  My insurance company (BCBS of IL) changed their policy in mid 2009 to include the DS.  Most reputable insurance companies (and even medicare) now cover the DS.  Long terms studies and the abolishment of DS myths are slowly making the DS more mainstream everyday.

One day there will be a procedure that will blow us all away, until then I will not stop telling people about this amazing surgery.

~GG
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Maria C
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« Reply #18 on: February 07, 2011, 07:36:31 AM »

Very well said Girly
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MacMadame
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« Reply #19 on: February 07, 2011, 12:52:38 PM »

Quote
the actual skill level needed to perform the RNY is fairly low. 
I have to disagree with this. RnY takes a fair amount of skill because of all the connections. You need to make them in a way that won't cause leaks. This is why there are a bunch of docs out there who only do bands. Because they just aren't skilled enough to do RnY.

Of course, some of those band-only docs are now doing the sleeve, which scares the bejezus out of me. If they can't do RnY without having an astronomical leak rate, I don't want them cutting up anyone's stomach. If you don't line up the staples properly on a sleeve, you can cause a lot of trouble. It's not as simple a procedure as it might appear on the surface.

IMO the reason so many docs do RnY is that it was first and it's been around forever and insurance has paid for it forever. They are comfortable with it and have a lot of experience with it.
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Maria C
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« Reply #20 on: February 07, 2011, 06:44:48 PM »

RNY is def. not simple I agree. Anything that mean cutting your intestines and reattaching them is tricky. However, the DS proves to be a more complicated procedure, that is all they were saying. Smiley..
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girlygirl1313
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« Reply #21 on: February 08, 2011, 06:49:12 AM »

exactly, one must have a lot of skill, training, experience to perform a proper RNY, but what I meant is that the DS goes so far beyond that I think most RNY surgeons don't see the point of honing these skills if it isn't more equitable for them

But IMO, DS doctors are the Cadillac of surgeons.  I would trust my surgeon to perform a liver transplant, that's how good he is. (Ironically his wife is head of abdominal transplants at Duke University)

Dr Sudan is a teaching surgeon at Duke University Medical School, before that at Creighton University.  He pioneered the use of the Davinci robot in use with in bariatric surgery.  How cool is that? When Dr Sudan accepted the position of Medical director of the Duke Metabolic Weightloss Clinic he brought with him the DS surgery and his unique robotic experience.  

In the beginning this surgery's merits was rejected by Duke (mainly by staff and fellow bariatric surgeons), but Dr Sudan still offered it, amongst the gripes and misinformation the rest of the clinic spewed.  Since then, Duke has changed it's tune, big time, about the merits of the surgery and there is a line out the door of people seeking DS with Sudan. (In the beginning, during all the misinfo they were disseminating, and to their horror, there was still a line out the door for DS)  I have also since heard rumors that Dr Torquati, a fellow Duke RNY surgeon has been interested in performing the DS as well.

These type surgeons are more interested in the anatomy and superior performance of a Duodenal Switch than the dictates of insurance companies.  

Very few people whom meet the qualifications for the DS are turned down on appeal because the insurance company hasn't a leg to stand on to refute the effectiveness and safety of the modern day BPD/DS.

I did NOT qualify for the DS surgery via my insurance, initially. I was not a 50+ BMI and I had ZERO comorbids.  But I challenged them anyway, presented valid evidence of it's superiority over the RNY and was approved on appeal.

European doctors are already performing the lower intestinal DS portion of the surgery as a superior option for non obese people to resolve diabetes.  It's only a matter of time before the US recognizes this surgery to help our ever growing diabetic community as well.
« Last Edit: February 08, 2011, 06:55:46 AM by girlygirl1313 » Logged
shepkatt
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« Reply #22 on: February 08, 2011, 08:31:12 AM »


European doctors are already performing the lower intestinal DS portion of the surgery as a superior option for non obese people to resolve diabetes.  It's only a matter of time before the US recognizes this surgery to help our ever growing diabetic community as well.


Now THAT would make me very happy (says the girl whose Daddy died from a myriad of crap including long term Diabetes)
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« Reply #23 on: February 08, 2011, 10:07:16 AM »


European doctors are already performing the lower intestinal DS portion of the surgery as a superior option for non obese people to resolve diabetes.  It's only a matter of time before the US recognizes this surgery to help our ever growing diabetic community as well.


Now THAT would make me very happy (says the girl whose Daddy died from a myriad of crap including long term Diabetes)

The UofMN is currently doing a study with the bypass portion of RNY for the same thing.
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« Reply #24 on: February 08, 2011, 10:17:53 AM »

Ok, we need to back up a bit I think.

The "over zealous" ones I was talking about are NOT the ones giving helpful information to people who see it.

There are people on OH, for example, by their own admission, believe anyone that has not had a DS has had the wrong surgery, and often tell them so. I often saw this go beyond just trying to inform someone, it included well, it was almost a mocking of those who chose a different surgery type.

It may happen by others who have had other surgeries, but I haven't seen it..  if it is, it would seem to be that it is on a much lesser degree.

I personally have nothing against anyone choosing DS over other surgeries. But those taking that over-zealous, preachy attitude out there do a disservice to everyone.

I do have one serious question to add to this...

When did the current version of DS become "the standard"?  I ask because I keep hearing about how it's changed to become better, but also that DS has the best long-term results?  I haven't seen any specifics on this in my browsing some of the mentioned sites.
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6-Mo Post-Op: 215 9-Mo Post-Op: 200 Lowest: 190 Now: 210
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